Culturally Appropriate Geriatric Care: Assessment

Important Caltural Issues

Filial Piety

Confucian teachings such as filial piety and respect for the elderly are important in Korean society.
Respectful gestures, such as bowing to those only one year older, maybe the norm. When greeting someone, good manners include that one bows slightly when shaking hands. However older Korean Americans who are less acculturated may not be accustomed to shaking hands. Verbal communication has different levels of honorifics when talking to those older than oneself. During the medical interview with the Korean elder it is important not to forget the formality and respectfulness that is needed to be conveyed during the meeting. Appearance is emphasized and also it is also important to sit up straight in meetings and, when standing, to avoid putting one’s hands into one’s pockets. In conversation, extended direct eye contact can be considered rude.

In Korean American communities, religious organizations (churches and temples) play an important social role, and may greatly facilitate getting older people the help that they need. It would be important for health providers to understand this relationship and to establish ties with religious organizations to serve the community.

Even when there are a number of Korean-Americans living in a community, the availability of Korean-language speaking health care providers is very limited. Hospitalization may be especially undesirable because of separation from family, preference for traditional medicine, and the unavailability of Korean food.

Due to cultural values on caring for elderly parents at home and other structural barriers, Korean Americans are underrepresented in nursing homes. However, the need for all family members to work, often more than one job, results in family stresses around the care needed at home. When the care needs of the elder far exceed what can be safely provided at home, it may be necessary to accept institutional care. In a national survey in Korea, about 19% of older Koreans expressed a willingness to enter a long-term care facility (Kim & Kim, 2004). In a study with Korean American elders in California (Min, 2005), 16% and 51% of the sample positively endorsed for the use of the use of nursing home under the two hypothetical conditions of hip fracture and stroke.

Communication with the health care provider is a problem for many Korean American elderly. Many Korean elders do not speak English, and may not speak English even if they had immigrated many years ago. One study revealed that 20% of the Korean American elders in LA County never spoke English and of those who did 44% felt that they spoke it poorly. They often live socially isolated from the community or live in households with limited English proficiency.

In a study of 200 older Koreans in Los Angeles most of the sample, about 95 % was born in Korea and on average had immigrated to the United States about 20 years ago. Despite this over 90% never spoke English or felt that they had fair or poor English language skills. This was also true for comprehension, writing and reading English skills. They used Korean as their primary language at home or in social settings. Also we need to be cognizant that some Korean elders may also not be literate in reading and writing especially, those with limited educational backgrounds. This is a source of embarrassment since education is very highly regarded in Korean culture. Korean elders may not be forthright about their educational status or hide their illiteracy.

Importance of Family and Kinship

Ideas of individualism and autonomy are unfamiliar in traditional Korean culture.
Characteristics that have been found among Korean families include: a high regard for filial piety; clearly divided family roles; family collectivity and interdependence which frequently overrides individualism and independence; and importance of good education (Chin, 1993; Kitano & Daniels, 1988). Korean culture emphasizes the family unit and the individual is a part of that unit and thus decisions are made collectively. Korean elders will often involve family members in decision making, and an important health decision will commonly involve their conferring with and relying on an eldest son, if one exists.

Gender issues

Traditional Korean society is patriarchal, and until recently, it was common for Korean women to stay at home to take care of the family. Korean immigrant families have had to change abruptly from having a male as the sole provider to situations where the women are also working outside of the home. This may be a source of conflict. In addition Korean women may feel burdened if they are expected to continue to perform all the household-related work in addition to their responsibilities in the workplace.

Even highly acculturated Korean Americans may regard it as natural for adult children to be responsible for aging parents and to provide care for them at home. Women customarily are the designated primary caregivers to home-dwelling Korean American elders. Care at home can be both emotionally and financially draining and even the closest and most supportive families are at risk for caregiver stress and burnout. Although present in all cultures, such situations in the Korean American community may result in high degrees of burden when caregivers feel the traditional pressures of providing all elder care personally and within the home setting.

Sensitive Issues

Korean culture is strongly influenced by Buddhism and the philosophy of Confucianism. Modesty is an important virtue especially for women in Confucianism, which may influence use of preventive health services such as a pap smears and mammography. It may also be difficult to illicit intimate details such as bodily functions and sexual history when the health care provider interviews the female patient.